What One Calls «Untriggered» Psychoses

ANNE-LYSY STEVENS What One Calls «Untriggered» Psychoses With Freud and Lacan, we have at our disposal precise markers for distinguishing the clinical structures, three in number: neurosis, psychosis, and perversion. However, in our practice, it isn t always easy to make a differential diagnosis. It often happens that these things don t give any evidence. This, of course, is not an objection to the validity of Lacanian theory, but rather indicates that the approach to a particular case -- in the sense that each subject is singular -- demands a fine and rigorous deciphering which cannot content itself with a few received opinions on the matter. It seems to me useful in this respect to clarify the term «untriggered psychosis.» It is a term that Lacan himself didn t raise to the dignity of a major concept as such, but that one uses often enough today in his School, and this, it seems to me, with a diversity of meanings. So that it doesn t become a catch-all notion and thus conceptually unsuitable, as is for example the term borderline in the field of psychiatry, one gains from discerning its scope and the consequences of its usage: why was this term introduced, what is it a response to, that is, to what clinical necessity and to what conceptualization of psychosis does it make reference? The difficulty that this term poses seems to draw on the fact that it joins two periods in Lacan s teaching. In his teaching, the approach to psychosis, ever-present, received different accents, even if an identical thread remained central: that of psychosis conceived in terms of the relation of the subject to the signifier and to jouissance. Two periods are commonly distinguished: that of the case study of Aimee (his medical dissertation of 1932) to Seminar III and the article «A question preliminary...; then twenty years later, «RSI» and «Le Sinthome» (seminar of 1975 which largely concerns James Joyce). In the first period, that many of us know well, which has become doxa as to psychosis, Lacan posits the thesis of the foreclosure of

2 ANNE-LYSY STEVENS the Name-of-the-father as determinant of psychotic structure, and elaborates the markers precious to us in accounting for the «triggering» of psychosis. The term triggering -- present in «untriggered psychosis» -- thus refers to this conceptualization. At the same time, it refers to the second conceptualization, since it is often in thinking of his seminar on Joyce of 1975 that one is tempted to use the term. However, Lacan no longer spoke in terms of triggered-off, or not triggered-off! Does this mean that the expression «untriggered psychosis» is not useful or suitable? Certainly not, for the two periods of Lacan s teaching are not incompatible. The second does not annul the first. One might simply say that its usage is a little fuzzy. To get one s bearings, one must distinguish at least two accepted meanings of the term. A first meaning sets out from the term to trigger-off and the elaborations of Seminar III and «A question preliminary...» When Lacan elaborated the moment of triggering-off -- I must even say, the logic of triggering off -- he uses different significations than the term has in the french language. To trigger-off [declencher] something is to «abruptly determine an action, put into motion, provoke» (Petit Robert). For example, to trigger-off a revolution, to launch, to begin. Thus, one has three states in this term, three clusters of significations: the eruptive, brusque character; the initial moment, the beginning; and finally the cause (what provokes). Setting out from Seminar III and the «Question preliminary...» one has the feeling that one can no longer separate the terms psychosis and triggeringoff, that the approach to the one is inextricable from the other. «Triggered psychosis» is thus the expression consecrated to designating psychosis as a set of phenomena which abruptly appear at a given moment. This brings up the question of what was there before the emergence of the phenomena characteristic of an avowed psychosis. What was Schreber, for example, before the triggering off -- which is to say, before around fifty years of age? Given that, for Lacan, the structures of neurosis, psychosis and perversion are particular modes of the relation of the subject to the signifier and to jouissance, which implies specific subjective positions without a point of passage between them, we respond that Schreber was psychotic. Certain people, like Katan, have advanced the term «prepsychosis» to designate the period antecedent to the surfacing of Schreber s crisis. We will see what fate Lacan gives this term in his Seminar III. This term has the merit of drawing our attention to the position of the subject before decompensation, but it has the great disadvantage of implying that there is a «before the psychosis» (thus, something else than psychosis). That is why the term of untriggered psychosis is more precise and more appropriate to the question of structure. Courtil Papers, 2002

What One Calls «Untriggered» Psychoses 3 Thus, a first definition of the term «untriggered psychosis» bears on what there is of psychosis before its shattering apparition. Concretely, how might one perceive the psychotic structure of Schreber before the first outbreak at fifty? This question is not a purely intellectual speculation, but has a great deal of importance in the practice; it is well known that the position one takes in the transference (whether in individual therapy or in institution) can create a conjunction propitious to the triggering off. In this first acceptation, the term of untriggered psychosis designates a period that one defines in the after-effect, after the triggering-off, as that which preceded it. The second, more up-to-date fashion of using this term designates a state in which someone is maintained, who has never properly speaking triggered-off, someone who hasn t located indubitably psychotic phenomena such as voices accompanied by delusional ideas, but that nothing else permits to diagnose as neurotic. These cases, when one has difficulty making a diagnosis, are frequent enough (for example, in case presentations). Here, one doesn t encounter the dimension of manifest, or even catastrophic decompensation, that return of the signifier in the real and the imaginary collapse that accompanies it. One doesn t find the manifestations of a triggered-off psychosis which, over a long treatment, may be «stabilized.» One doesn t witness the noisy apparition of the psychosis, yet one can locate the psychotic structure from the phenomena that only the tools Lacan gave us permit to situate as psychotic. Sometimes, in this sense of the term untriggered psychosis, one speaks of a «low-volume psychosis.» Posing the question in this way, one is necessarily brought to ask two questions: how had the edifice been able to hold up so long? And how is it that, in certain cases, in spite of a propitious conjuncture, the triggering-off doesn t take place? I will take up Marie-Helene Brousse s formulation: «Under what conditions does a psychotic structure escape the surging up of psychotic phenomena? In other words, how do we account for the not-triggered-off?» 1 Lacan had been brought to give account of this non-triggering in the second period of his teaching on psychosis, when he became interested in Joyce. One discerns in this writer the elements of a psychotic structure, except that the psychosis never broke out. What allows things to hold together is what Lacan called a substitute [suppleance] -- a term which has a very precise meaning, much more restricted than in its current usage among us. Suppleance is something that covers up a hole, which corrects it, repairs an error in the borromean knot. It concerns something that comes, not as an after-effect to repair a default rendered apparent by the triggeringoff, but a function which has the effect of covering the default in such a

4 ANNE-LYSY STEVENS way that the triggering-off doesn t take place. Thus Colette Soler, in her article «The enigmatic experience of psychosis, from Schreber to Joyce,» clearly opposes Schreber and Joyce: Schreber, at the end of his delirium, is «a re-established subject that one might call already treated, without psychoanalysis: it is a case of self-healing outside of the transference. Joyce, would be rather a case of self-prevention of the illness.» 2 Joyce is thus a case of untriggered psychosis. But this time, if one follows strictly the articulation of Lacan, in the strongest sense of «untriggered!» From these two definitions of «untriggered psychosis» one can deduce that the problem in the clinic is double: First, how do we locate the psychosis before or without its striking manifestation, which is to say, how do we locate the effects of foreclosure in the absence of voices or a collapse of the subject s world (=P 0 ---> 0 ). Then, once located, how do we know what is the mode of the solution adopted in each case, how do we distinguish a suppleance in the sense of «self-prevention of the illness» as in the case of Joyce, from a construction which, certainly, remedies the hole left by the foreclosure, but doesn t succeed in avoiding the triggering-off, the return in the real, a construction which might even lead to it. In her long article on Rousseau published in Ornicar?, «Rousseau the Symbol,» Colette Soler opposes precisely the Joycian solution and the course taken by Rousseau. She doesn t hesitate to conclude that «Rousseau failed where Joyce succeeded,» because «he didn t raise his know-how with language to the function of a symptom. His art is an art of the symbolic...» 3 and not of the letter as was Joyce s. To understand this distinction, one must grasp the new definition of symptom given by Lacan in 1975: it is no longer simply the structure of the metaphor, signifier over the signified, but of the letter which condenses the jouissance in an S1 outside the chain, which thus has a slope in the real, non-dialectic. I cannot develop this question of Joycian suppleance here and must content myself to underline that to advance on the problem of untriggered psychoses, one must study these seminars of Lacan s («RSI» and «Le sinthome»). But it seems certain to me also that the advances Lacan makes do not annul or render inoperative the precedent theories, and that, to put it a little schematically, the operator P 0 ---> 0 remains in force. Thus it is always a matter of locating the effects of foreclosure in the subject s discourse and finding, in this same discourse and through this discourse, the modes of solutions to the inconsistency of the Other. The effects of foreclosure, whether the psychosis has been triggered-off or not, are to be found in the relationship of the signifier and the imaginary. In the different studies to which I make reference in my Courtil Papers, 2002

What One Calls «Untriggered» Psychoses 5 bibliography, the diagnosis in one case is supported by a language usage that, at rare moments, produces a neologism (in the sense that Lacan speaks of it in Seminar III) (A. Stevens); in another case on an «asubjectivation of slip» (Guy Trobas). Facts of discourse, then. In Joyce s case, for example, he never had a delirium, nor an outbreak. For Joyce, one locates the psychotic structure notably in the «epiphanies,» close to the phenomenon of voices insofar as return in the real of a signifier detached from the chain, but also in the relation to the body. Lacan drew our attention to Joyce s experiences of estrangement from his own body, that one notes in many places in Portrait of the Artist. He notes a «letting go in respect to his own body.» When, for example, Stephen had received slaps on his hands, he imagined them painful, and complains as if they weren t his hands, but someone else s whom he might pity. Elsewhere, in his correspondence, Joyce compares himself to a robe without inhabitant. 4 Lacan advances, then, that Joyce s art holds something together in the Borromean knot («RSI»), fixes it where it is coming undone, thus provoking a sliding of the imaginary outside the knot. Through his art, not only does he make a name for himself (which substitutes for the paternal default), but this art substitutes for the missing phallic signification. This suppleance, Lacan calls it ego for Joyce (that which evokes the image of the ego), in saying that the ego of Joyce is not a body, but his art. In broaching this seminar of Lacan s which comes out of the second elaboration of the psychoses and a generalization of the symptom, many questions or remarks spring to mind which are so many arrows pointing to work to be done. A first question is this one: What is exportable in what Lacan advances about Joyce? Of course, Lacan doesn t give in to vulgar, applied psychoanalysis, but he uses Joyce as a paradigm to advance something of his theorization. Thus, it is something exportable, but up to where, to what limits? In any case, each psychotic subject who writes is not Joyce. It would be better to let go of the sometimes, even often noticeable fascination for the psychotic patient once he has taken up the pen or paintbrush and to look two times before heartily decreeing that it s suppleance. Lacan s advances shed light on the affinities of the psychotic structure with a «push-to-writing» or creation. One might ask oneself what place is left to the «push-to-the-woman» accentuated in the «Question preliminary...»? The articulation of the symptom to the «letter» in 1975 leads one to think of suppleance only in terms of artistic creation. Aren t there other possible modes of suppleance? On the other hand, why are there so many more renown psychotic artists (Maupassant, Van Gogh, Nerval, Rousseau) than philosophers or mathematicians (Kierkegaard and Cantor) who fail to ward off the triggering?

6 ANNE-LYSY STEVENS Another question is that of the distinction between the Joycian ego and what Lacan calls in Seminar III «imaginary crutches.» In brief, in the «Question preliminary» or Seminar III, Lacan doesn t develop the question of psychosis without triggering, but we find two indications about psychosis before its triggering-off. In the «Question preliminary,» a single sentence makes allusion to what had permitted Schreber to «hold up» until then. It was an identification, «any identification» Lacan writes: «Here the identification, whatever it may be, by which the subject assumed the desire of the mother, triggers off, as a result of being shaken, the dissolution of the imaginary tripod...» 5 In Seminar III he is more explicit, but not about Schreber. He brings in Katan s case of an adolescent. 6 The image of «crutches» echoes that of «footstools.» 7 The feet of the stools are the signifying fulcrums which support the little world of each of us. «Not every stool has four feet. There are some that stand upright on three. Here, though, there is no question of their lacking any, otherwise things go very badly indeed.» 8 When there are only three feet, something compensates «the signifying absence.» 9 It is an imaginary compensation. The young man of whom Katan speaks cannot accede to virility through the Oedipus, through the Name-of-the-father, since it is foreclosed, and he falls back on the paternal image. He tries to conquer virility «by means of imitation, of a latching on, following the example of one of his friends.» 10 He does everything just like the other; he identifies to him. Lacan recognized in this the mechanism of «as if» in schizophrenia, as it has been developed by H. Deutsch. Further on, he evokes the psychopathic threads in exceptionally paternal personalities, noting that this thread is only supported by the image of what the paternal function is reduced to for these personalities. 11 It must be noted that the relation to this image is not dialectized by the signifier. The captivity is disproportional and the alienation radical. It isn t a relation to the other, in which the subject defines itself as ego in relation to the other in a mutually exclusive way. The subject can only compensate the lacking signifier with «a series of purely conformist identifications with characters who will give him the feeling for what one has to do to be a man.» 12 This type of identification must be distinguished from hysterical identification, even if this latter might seem very labile in its manifestations. The alienating capture is already, in itself, a trace of P 0. The term «crutch» also denotes the extremely precarious character of the compensation -- as opposed to the «ego» of Joyce. Courtil Papers, 2002

What One Calls «Untriggered» Psychoses 7 Bibliography A non-exhaustive bibliography about untriggered psychosis. M.-H. Brousse, «Question de suppleance,» Ornicar? #47, 1988; pp. 65-73. H. Deutsch, «Some Forms of Emotional Disturbance and Their Relationship to Schizophrenia,» The Psychoanalytic Quarterly #11, 1942; pp. 301-321. F. Gorog. «Joyce le prudent.» La Cause freudienne #23, 1993; pp. 65-74. - 109. -----. «Le livre du juge.» La Cause freudienne #29, 1995; pp. 101 M. Katan. «La phase prepsychotique de Schreber (1953)» Le cas Schreber (vol. coll.), PUF: Paris, 1979; pp. 91-107. -----. «Structural aspects of a case of schizophrenia.» Psychoanalytic Study of the Child V, 1950; pp. 175-211. J. Lacan. The Seminar of Jacques Lacan, Book III: The Psychoses (1955-56). Ed. Jacques-Alain Miller, trans. Grigg. Routledge, 1993. -----. «On a question preliminary to any possible treatment of psychosis.» Ecrits: A Selection. trans. Sheridan. Norton, 1977; pp. 179-226. -----. Le Seminaire, Livre XXIII, Le sinthome (1975-76). in Ornicar? nos. 6-11. J.-A. Miller. «Clinique ironique.» La Cause freudienne #23, Op. cit.; pp. 7-13. P. Naveau. «Le declenchement de la psychose.» Ornicar? #44, 1988; pp. 77-87. P. Skriabine. «Clinique de la suppleance.» Ornicar? #44, Op. cit.; pp. 65-76.

8 ANNE-LYSY STEVENS C. Soler. «Deux vocations, deux ecritures.» La lettre mensuelle #81, 1989. -----. «Rousseau le symbole.» Ornicar? #48, 1989; pp. 30-57. -----. «L experience enigmatique du psychotique, de Schreber a Joyce.» La Cause freudienne #23, Op. cit.; pp. 50-59. A. Stevens. «Aux limites de la psychose.» Quarto #47, Op. cit.; pp. 74-79. -----. «Delire et suppleance.» Quarto #42, 1990; pp. 33-37. G. Trobas. «Le symbolique altere.» Ornicar? #47, Op. cit.; pp. 80-87. 1 Marie-Helene Brousse. «Question de suppleance.» Ornicar? #47, 1988; pp. 65-73. One finds in this same issue two other articles, case studies, on untriggered psychosis by Alexander Stevens and Guy Trobas. 2 Colette Soler. «L experience enigmatique du psychotique, de Schreber a Joyce.» La cause freudienne #23, 1993; pp. 50-59. 3 Colette Soler. «Rousseau, le symbole.» Ornicar? #48, 1989; pp. 30-57. 4 See the article by Francoise Gorog, «Joyce le prudent.» La Cause freudienne #23, 1993; pp. 65-74. 5 Jacques Lacan. «On a question preliminary to any possible treatment of psychosis.» Ecrits: A Selection. trans. A. Sheridan. Norton: 1977; p. 207. 6 Jacques Lacan. The Seminar of Jacques Lacan, Book III: The Psychoses (1955-1956). Ed. J.-A. Miller, trans. R Grigg. Routledge, 1993; p. 192-193. 7 Ibid.; p. 205 and p. 203. 8 Ibid.; p. 203. 9 Ibid.; p. 205. 10 Ibid.; p. 192. 11 Ibid.; p. 204. 12 Ibid.; p. 205. Courtil Papers, 2002